Salerno G, Daniels I R, Brown G, Norman A R, Moran B J, Heald R J
Department of Colorectal Research, Pelican Cancer Foundation, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, UK.
World J Surg. 2007 Jun;31(6):1313-20. doi: 10.1007/s00268-007-9007-5.
The objective of this study was to assess the value of preoperative pelvimetry, using magnetic resonance imaging (MRI), in predicting the risk of an involved circumferential resection margin (CRM) in a group of patients with operable rectal cancer.
A cohort of 186 patients from the MERCURY study was selected. These patients' histological CRM status was compared against 14 pelvimetry parameters measured from the preoperative MRI. These measurements were taken by one of the investigators (G.S.), who was blinded to the final CRM status.
There was no correlation between the pelvimetry and the CRM status. However, there was a difference in the height of the rectal cancer and the positive CRM rate (p = 0.011). Of 61 patients with low rectal cancer, 10 had positive CRM at histology (16.4% with CI 8.2%-22.1%) compared with 5 of 110 patients with mid/upper rectal cancers (4.5% with CI 0.7%-8.4%).
Magnetic resonance imaging can predict clear margins in most cases of rectal cancer. Circumferential resection margin positivity cannot be predicted from pelvimetry in patients with rectal cancer selected for curative surgery. The only predictive factor for a positive CRM in the patients studied was tumor height.
本研究的目的是评估使用磁共振成像（MRI）进行术前骨盆测量在预测一组可手术直肠癌患者环周切缘（CRM）受累风险中的价值。
从MERCURY研究中选取了186例患者。将这些患者的组织学CRM状态与术前MRI测量的14项骨盆测量参数进行比较。这些测量由一名研究人员（G.S.）进行，该研究人员对最终的CRM状态不知情。
骨盆测量与CRM状态之间无相关性。然而，直肠癌的高度与CRM阳性率存在差异（p = 0.011）。在61例低位直肠癌患者中，10例组织学检查CRM阳性（16.4%，CI为8.2%-22.1%），而在110例中/高位直肠癌患者中，有5例CRM阳性（4.5%，CI为0.7%-8.4%）。
磁共振成像在大多数直肠癌病例中可预测切缘阴性。对于选择进行根治性手术的直肠癌患者，无法通过骨盆测量预测环周切缘阳性。在所研究的患者中，CRM阳性的唯一预测因素是肿瘤高度。
